Facilitators and Barriers of Self-management in Pediatric Type 1 Diabetes: A Systematic Review

Vollständiger Abstract

Worum geht es in dieser Arbeit?

Context: Self-management of type 1 diabetes in children and adolescents is critical for achieving optimal health outcomes. Identifying facilitators and barriers can guide the development of effective interventions. Objectives: This systematic review synthesizes interventional studies to examine key factors influencing self-management and their impact on outcomes. Methods: Following preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 guidelines, PubMed, Scopus, and Web of Science were searched up to August 10, 2025. Eligible studies included randomized controlled trials (RCTs) and quasi-experimental designs. Study quality was assessed using the risk of bias 2 (RoB 2) tool for randomized trials and risk of bias in non-randomized studies (non-RCTs) of interventions (ROBINS-I) for non-randomized studies. Results: Thirty-four studies comprising 4,584 participants aged 3 - 19 years were included. Of these, 65% were rated as low risk of bias and 35% as moderate risk. Interventions mainly involved self-management education (55%), family-centered programs (41%), digital technologies (35%), motivational strategies (32%), and psychological support (29%). Key facilitators included family involvement (47%), structured and repeated education (41%), healthcare team engagement (35%), motivational strategies (32%), and technological tools (30%). Barriers included fear of hypoglycemia (FOH, 29%), emotional stress (25%), lack of peer support (21%), limited access to educational resources (18%), cultural or language challenges (15%), and insufficient school-based education (12%). Interventions generally improved hemoglobin A1c (HbA1c), self-care behaviors, knowledge, self-efficacy, and quality of life. Conclusions: This review underscores the multidimensional nature of self-management in pediatric type 1 diabetes. Effective programs should address both individual and contextual barriers while leveraging facilitators such as family support and technology. Given the generally low-to-moderate risk of bias, findings are robust but highlight the need for culturally tailored and longitudinal research.